APA: Virtual Reality PTSD Therapy Shows Promise in Iraq Veterans

Action Points

Explain to interested patients that preliminary data from a study of a treatment for PTSD using virtual reality showed it may be effective.

Caution that the study is still underway and the data represented only a small number of patients.

Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

WASHINGTON, May 8 -- Posttraumatic stress disorder among Iraq war veterans may be treatable by exposure therapy using virtual reality technology, a researcher said here.

With limited data on the first 22 patients of the 150 patients expected to be enrolled in a randomized trial, the therapy appears to be producing substantial reductions in PTSD symptom scores, reported Barbara Rothbaum, Ph.D., of Emory, at the American Psychiatric Association meeting.

The trial is testing virtual reality-based exposure therapy combined with either alprazolam (Xanax), d-cycloserine, or placebo.

Mean scores for the 22 patients on the Clinician Administered PTSD Scale were 83 at baseline. Among 14 patients who had completed three months in the study, mean scores declined to 60.

Two Iraq veterans who have completed a full year in the study had scores of 21, Dr. Rothbaum said.

Intensity of startle responses after six months of treatment declined 75% from baseline, she added.

All patients so far appear to have benefited to some degree from the therapy.

The drug assignments are double-blind, Dr. Rothbaum said. The blinding remains in place, so the preliminary signs of efficacy are likely due to the virtual reality therapy, she said.

Dr. Rothbaum said the system can simulate urban foot patrols and Humvees traveling along a desert highway.

She showed a video clip indicating that the animated graphics are nearly as realistic as recent video games.

Patients describe the traumatic event, such as a bomb explosion while in a Humvee convoy, to a therapist who adjusts the visuals, audio, smells, and vibrations to approximate the description.

The premise of exposure therapy is to have the patient relive the trauma over and over, so that the memory no longer rekindles the intense hyperarousal and fear responses.

Dr. Rothbaum has previously used the system successfully in treating PTSD associated with rape, and also to eliminate phobias such as fear of heights.

In the Iraq veterans study, expected to be completed in 2011, patients receive five sessions of virtual reality-based exposure therapy. The study drugs are given just before each session.

D-cycloserine is an old-line tuberculosis drug that was later discovered to have neuropsychiatric effects. It is a partial agonist of the N-methyl-D-aspartate receptor. Past studies have indicated that it helps in extinguishing fear memories.

She said neither d-cycloserine nor alprazolam would be expected to affect PTSD symptoms by themselves. The earlier studies have indicated that the exposure therapy is a necessary component.

Douglas Zatzick, M.D., a PTSD researcher at the University of Washington, commented that the virtual reality therapy holds great promise for PTSD.

But he was unsure that funding will be available to provide it to the tens of thousands of Iraq and Afghanistan veterans who are coming home with PTSD.

"That's really up to the VA and Defense Department," he said.

Dr. Rothbaum added that she and her colleagues have begun testing a preventive treatment for PTSD in civilian settings.

It begins immediately after the trauma, while the patient is still in the emergency room. It is talk therapy, with no drugs or virtual reality equipment involved.

She said the intervention tries to add positive elements to patients' memories of the trauma. The hope is that patients then will not remember the incident as overwhelmingly fearful and negative.

"It's like getting right back on the bicycle after falling off," she said. "We're changing the memory so it's not something you have to get over."

Dr. Rothbaum said she is now seeking funding for a formal study of the intervention.

Dr. Rothbaum is co-owner of Virtually Better Inc., a spinoff company seeking to commercialize the virtual reality therapy.

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